Abstract
BackgroundPercutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP) for treating painful osteoporotic vertebral fractures are controversial.ObjectiveWe assessed the regional variation in the use of VP/BKP in Switzerland.MethodsWe conducted a population-based small area variation analysis using patient discharge data for VP/BKP from all Swiss hospitals and Swiss census data for calendar years 2012/13. We derived hospital service areas (HSAs) by analyzing patient flows, assigning regions from which most residents were discharged to the same VP/BKP specific HSA. We calculated age-/sex-standardized mean VP/BKP-rates and measures of regional variation (extremal quotient [EQ], systematic component of variation [SCV]). We estimated the reduction in variation of VP/BKP rates using negative binomial regression, with adjustment for patient demographic and regional socioeconomic factors (socioeconomic status, urbanization, and language region). We considered the residual, unexplained variation most likely to be unwarranted.ResultsOverall, 4955 VP/BKPs were performed in Switzerland in 2012/13. The age-/sex-standardized mean VP/BKP rate was 4.6/10,000 persons and ranged from 1.0 to 10.1 across 26 HSAs. The EQ was 10.2 and the SCV 57.6, indicating a large variation across VP/BKP specific HSAs. After adjustment for demographic and socioeconomic factors, the total reduction in variance was 32.2% only, with the larger part of the variation remaining unexplained.ConclusionsWe found a 10-fold variation in VP/BKP rates across Swiss VP/BKP specific HSAs. As only one third of the variation was explained by differences in patient demographics and regional socioeconomic factors, VP/BKP in the highest-use areas may, at least partially, represent overtreatment.
Highlights
Symptomatic vertebral fractures are common in the elderly and potentially result in pain, deformity, disability, and substantial costs [1, 2]
We found a 10-fold variation in VP/balloon kyphoplasty (BKP) rates across Swiss VP/BKP specific hospital service areas (HSAs)
As only one third of the variation was explained by differences in patient demographics and regional socioeconomic factors, VP/BKP in the highest-use areas may, at least partially, represent overtreatment
Summary
Symptomatic vertebral fractures are common in the elderly and potentially result in pain, deformity, disability, and substantial costs [1, 2]. To which patient VP or BKP should be recommended remained highly controversial This controversy was fueled by the open label VERTOS II trial [6] and the sham procedure controlled VAPOUR trial [17] that showed a decreased pain level in favor of VP in patients with acute fractures with a pain duration of
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